Principal clinical presentation is odynophagia, dysphagia or retrosternal chest pain.
It can be accompanied by oral ulcers and a maculopapular rash in the upper body 2.
Esophagitis in HIV patients with low CD4 counts is usually caused by an infectious etiology, such as cytomegalovirus (CMV), Herpes virus or Candida. However, there are cases where the etiology is not identified in cultures, electron microscopy, or immunohistochemical tests. In these cases, HIV itself has been proposed to be etiology.
Esophageal biopsy shows an inflammatory reaction at the level of the ulcer with negative PAS and immunohistochemical tests for CMV and Herpesvirus 4. Idiopathic esophagitis of HIV is a diagnosis of exclusion.
Fluoroscopy / barium studies
Usually presents as an oval or diamond-shaped flat giant esophageal ulcer, with or without small satellite ulcers. Double-contrast esophagogram may show edema represented as a peripheral radiolucent rim.
Treatment and prognosis
- highly active antiretroviral therapy (HAART)
- oral steroids
The condition improves with an increasing CD4 count.
Idiopathic esophagitis of HIV is often indistinguishable from CMV esophagitis 1,3. Endoscopic evaluation with tissue sampling is imperative in HIV-patients with giant esophageal ulcers to differentiate these two entities as CMV is treated with antiviral medication that can be relatively toxic 1.
- 1. Levine MS, Rubesin SE. Diseases of the esophagus: diagnosis with esophagography. Radiology. 237 (2): 414-27. doi:10.1148/radiol.2372050199 - Pubmed
- 2. Levine MS, Loercher G, Katzka DA, Herlinger H, Rubesin SE, Laufer I. Giant, human immunodeficiency virus-related ulcers in the esophagus. Radiology. 180 (2): 323-6. doi:10.1148/radiology.180.2.2068293 - Pubmed
- 3. Sor S, Levine MS, Kowalski TE, Laufer I, Rubesin SE, Herlinger H. Giant ulcers of the esophagus in patients with human immunodeficiency virus: clinical, radiographic, and pathologic findings. Radiology. 194 (2): 447-51. doi:10.1148/radiology.194.2.7824725 - Pubmed
- 4. Dragean CA, Bogdan I, Azzouzzi K, Goncette L. Giant idiopathic ulcer of esophagus in the context of acquired immunodeficiency syndrome (AIDS). JBR-BTR : organe de la Societe royale belge de radiologie (SRBR) = orgaan van de Koninklijke Belgische Vereniging voor Radiologie (KBVR). 96 (2): 72-4. Pubmed
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